Method for guiding ablative therapy of cardiac arrythmias

描述（由申请人提供）： 从成本和患者安全的角度来看，心室导管消融术已被确定为治疗心律失常的最理想方法，但其成功率尚未得到广泛认可。这主要是因为这种治疗方式几乎完全依赖于负责医生的经验和能力，通过内镜标测来识别消融部位。在这项资助申请中，我们的目标是研究一种新方法的能力，以快速，可靠和安全地识别心律失常的起源部位。我们的方法依赖于分配一个等效的移动偶极子的属性的每个阶段的心动周期，然后逆解析的偶极子的属性（位置和强度）。我们的假设是，逆偶极子解决方案将准确地定位在心动周期中的点时，电活动仍然是焦点，去极化波出现的焦点。我们将构建一个最先进的系统，旨在为心脏电生理学家提供一种工具，该工具将有助于识别心脏中的心律失常部位，并将能够准确引导消融导管到达心律失常的起源部位。我们将通过盐水箱和动物研究来评估其性能。在后一项研究中，我们将最终比较通过等效偶极子解决方案确定的部位与操作员最初确定的部位以及最终导致室性心动过速诱导消除的部位。执行三维标测和实时查看心律失常的能力比标准荧光透视二维成像或激动标测领先了一步。此外，我们的方法有望减少进行标测所需的时间，并使患者耐受良好。成功导管消融室性心动过速的影响可能是（i）降低心源性猝死的发生率，（ii）降低植入式心律转复电击的频率，以及（iii）减少抗心律失常药物及其潜在促心律失常和/或其他副作用的需求。

DESCRIPTION (provided by applicant): Ventricular catheter ablation has been established as the most desirable from cost and patient safety point of view approach in treating cardiac arrhythmias, yet its success rate has not broad acceptance. This is primarily because this treatment modality relies almost entirely on the experience and abilities of the physician in charge to identify the ablative site through endocardial mapping. In this grant application we aim to investigate the ability of a new method to rapidly, reliably and safely identify the site of origin of the arrhythmia. Our method relies on assigning properties of an equivalent moving dipole to each phase of the cardiac cycle and then inversely resolving the properties (location and strength) of the dipole. Our hypothesis is that the inverse dipole solution will accurately locate the arrhythmogenic focus at the point in the cardiac cycle when electrical activity is still focal, as the depolarization wave emerges from the focus. We will build a state-of-art system aimed to provide the cardiac electrophysiologist with a tool that will facilitate the identification of the site of the arrhythmia in the heart and will enable the accurate guiding of the ablation catheter to the site of origin of that arrhythmia. We will evaluate its performance by means of saline tank and animal studies. In the latter study, we will ultimately compare the location of the site identified by means of the equivalent dipole solution with the site initially identified by the operator as well as the site which ultimately results in the abolition of inducibility of ventricular tachycardia. The ability to perform three dimensional mapping and view the arrhythmia in real-time represents a step ahead from the standard fluoroscopic two-dimensional imaging or activation mapping. Furthermore our methodology promises to reduce the time required to perform the mapping and make it well tolerated from the patient. The impact of successful catheter ablation of ventricular tachycardia may be to (i) reduce the incidence of sudden cardiac death, (ii) reduce the frequency of implantable cardioverter shocks, and (iii) decrease the need of anti-arrhythmic medications with their potentially pro-arrhythmic and/or other side effects.